CPT code 26497 is used to identify a surgical procedure for transferring a finger tendon to restore function.
CPT code 26497 is used to describe a surgical procedure involving the transfer of a tendon in the finger. This procedure is typically performed to restore function or movement in a finger that has been affected by injury or disease. The transfer involves relocating a tendon from one area to another to improve the patient's ability to grasp or manipulate objects. This code is essential for healthcare providers to accurately document and bill for the surgical intervention related to finger tendon issues.
When billing for CPT code 26497 (Finger tendon transfer), several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both hands or fingers.
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed on a different digit or area that is not considered part of the primary procedure.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated on the same finger by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is applicable if the patient requires a return to the operating room for a related procedure within the global period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier should be used if a different procedure is performed during the postoperative period that is unrelated to the original procedure.
7. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left hand or finger.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right hand or finger.
9. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is applicable when the patient has multiple encounters on the same day, and the procedure is part of those encounters.
It is essential to review the specific circumstances of the procedure and the payer guidelines to determine the appropriate modifiers to use for accurate billing and reimbursement.
CPT code 26497 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment rates.
Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 26497. Each MAC may have unique policies that could influence the reimbursement process, so staying informed through these channels ensures accurate and timely payment.
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